Rosemary C Chamberlain1, Kelly Fleetwood2, Sarah H Wild3, Helen M Colhoun4, Robert S Lindsay5, John R Petrie6, Rory J McCrimmon7, Fraser Gibb8, Sam Philip9, Naveed Sattar10, Brian Kennon11, Graham P Leese12. 1. 1Department of Diabetes and Endocrinology, Ninewells Hospital, Dundee, U.K. 2. 2Usher Institute, University of Edinburgh, Edinburgh, U.K. 3. 3Usher Institute, University of Edinburgh, Edinburgh, U.K. 4. 4Institute of Genetics and Cancer, University of Edinburgh, Edinburgh, U.K. 5. 5Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K. 6. 6Institute of Cardiovascular and Medical Sciences, BHF Glasgow Cardiovascular Research Centre, University of Glasgow, Glasgow, U.K. 7. 7School of Medicine, University of Dundee, Dundee, U.K. 8. 8Edinburgh Centre for Endocrinology and Diabetes, Royal Infirmary of Edinburgh, Edinburgh, U.K. 9. 9Diabetes Centre, Aberdeen Royal Infirmary, Aberdeen, U.K. 10. 10Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, U.K. 11. 11Diabetes Centre, New Victoria Hospital, Glasgow, U.K. 12. 12Department of Diabetes and Endocrinology, Ninewells Hospital, Dundee, U.K.
Abstract
OBJECTIVE: To describe incidence of foot ulceration and amputation-free survival associated with foot ulceration status in a national population-based cohort study of people with diabetes. RESEARCH DESIGN AND METHODS: The study population included 233,459 people with diabetes who were alive in Scotland on 1 January 2012 identified from the national population-based register (national prevalence 4.9%). Characteristics of patients identified from linked hospital and mortality records during follow-up to the end of November 2017 were compared by outcome. Cox regression was used to assess the association between history of foot ulcer and amputation-free survival. RESULTS: The population included 23,395 people with type 1 diabetes and 210,064 people with type 2 diabetes. In total there were 13,093 (5.6%) people who had a previous foot ulceration, 9,023 people who developed a first ulcer, 48,995 who died, and 2,866 who underwent minor or major amputation during follow-up. Overall incidence of first-time foot ulcers was 7.8 per 1,000 person-years (95% CI7.6-7.9) and 11.2 (11.0-11.4) for any ulcer. Risk factors for reduced amputation-free survival included social deprivation, mental illness, and being underweight in addition to conventional cardiovascular risk factors. Adjusted hazard ratios (95% CI) were 2.09 (1.89-2.31) for type 1 diabetes and 1.65 (1.60-1.70) for type 2 diabetes. CONCLUSIONS: The overall incidence of foot ulceration in a population-based study of people with diabetes was 11.2 per 1,000 person-years. Foot ulceration is associated with lower amputation-free survival rate, a potential measure of effectiveness of care among people with diabetes. Mental illness and social deprivation are also highlighted as risk factors.
OBJECTIVE: To describe incidence of foot ulceration and amputation-free survival associated with foot ulceration status in a national population-based cohort study of people with diabetes. RESEARCH DESIGN AND METHODS: The study population included 233,459 people with diabetes who were alive in Scotland on 1 January 2012 identified from the national population-based register (national prevalence 4.9%). Characteristics of patients identified from linked hospital and mortality records during follow-up to the end of November 2017 were compared by outcome. Cox regression was used to assess the association between history of foot ulcer and amputation-free survival. RESULTS: The population included 23,395 people with type 1 diabetes and 210,064 people with type 2 diabetes. In total there were 13,093 (5.6%) people who had a previous foot ulceration, 9,023 people who developed a first ulcer, 48,995 who died, and 2,866 who underwent minor or major amputation during follow-up. Overall incidence of first-time foot ulcers was 7.8 per 1,000 person-years (95% CI7.6-7.9) and 11.2 (11.0-11.4) for any ulcer. Risk factors for reduced amputation-free survival included social deprivation, mental illness, and being underweight in addition to conventional cardiovascular risk factors. Adjusted hazard ratios (95% CI) were 2.09 (1.89-2.31) for type 1 diabetes and 1.65 (1.60-1.70) for type 2 diabetes. CONCLUSIONS: The overall incidence of foot ulceration in a population-based study of people with diabetes was 11.2 per 1,000 person-years. Foot ulceration is associated with lower amputation-free survival rate, a potential measure of effectiveness of care among people with diabetes. Mental illness and social deprivation are also highlighted as risk factors.
Authors: Ilker Uçkay; Vinoth Yogarasa; Felix W A Waibel; Annette Seiler-Bänziger; Maja Kuhn; Margrit Sahli; Martin C Berli; Benjamin A Lipsky; Madlaina Schöni Journal: J Diabetes Res Date: 2022-08-05 Impact factor: 4.061
Authors: Stuart J McGurnaghan; Luke A K Blackbourn; Thomas M Caparrotta; Joseph Mellor; Anna Barnett; Andy Collier; Naveed Sattar; John McKnight; John Petrie; Sam Philip; Robert Lindsay; Katherine Hughes; David McAllister; Graham P Leese; Ewan R Pearson; Sarah Wild; Paul M McKeigue; Helen M Colhoun Journal: BMJ Open Date: 2022-10-12 Impact factor: 3.006